Correspondence

Further reflections of the role of artificial intelligence in acute medicine

Correspondence, Volume 22, Issue 4, Pages 169 – 268 (2023)

We read with great interest the article “Artificial Intelligence: its Future and Impact on Acute Medicine”. Regarding the historical perspective on artificial intelligence (AI) origins, we believe the role of John von Neumann (1903-1957) also deserves emphasis.

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Ultrasound for Lumbar Punctures – An Invaluable tool for the Acute Physician

Correspondence, Volume 22, Issue 2, Pages 57 – 108 (2023)

The traditional procedure of identifying anatomical landmarks when performing lumbar punctures can lead to a failure rate of 19%.
The Society of Hospital Medicine have published a statement, recommending use of ultrasound (US) guidance for all adult lumbar punctures (LP).
A recent meta-analysis found several advantages of point of care US guided LP: higher success rate and diminished pain.
US assisted LP is easy to learn, integrating ultrasound guided LP into Acute Medicine curriculum, could lead to better patient outcome.

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The COVID-19 pandemic has not affected the mortality for patients admitted with pneumonia in Denmark

Correspondence, Volume 22, Issue 1, Pages 1 – 56 (2023)

During the COVID-19 pandemic, several hospital systems observed a reduction in patients with respiratory complaints. Using the Danish national registers, we conducted an observational study on disease severity and 30-day all-cause mortality for acutely admitted pneumonia patients before (3/19-3/20) and during (3/20-2/21) the pandemic. We calculated mortality rate ratios and Cox regression analyses. We identified 54,405 patients and during the pandemic, patients were older, more likely to be male, had more co-morbidity and a lower albumin on admission. Crude mortality was higher during the pandemic (8.4 vs. 6.9%). Adjusted hazard ratio for 30-day all-cause mortality was 1.07 (95%CI 1.01-1.14). We showed a small but significant, increase in mortality risk for patients admitted to hospital during the COVID-19 pandemic in Denmark.

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Technology-enabled multidisciplinary team in-reach for oral corticosteroid stewardship and optimizing care of suspected airways disease exacerbations

Correspondence, Volume 21, Issue 4, Pages 165-208 (2022)

Overuse of corticosteroids is an important problem not only in asthma but also the management of other airways diseases including bronchiectasis and COPD and results in associated risks of serious side effects and irreversible harm. We report a pilot using an in-reach solution to review patients, optimise their care and facilitate early discharge. We discharged >20% of our patients immediately, which is potentially a significant reduction in hospital bed use and, most importantly, through this approach we were able to establish early diagnosis and reduce inappropriate oral corticosteroid use.

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Evaluation of a basic point-of-care ultrasound course for residents in internal medicine

Correspondence, Volume 21, Issue 3, Pages 121-164 (2022)

Point-of-care ultrasound (POCUS) integrates imaging into the physical examination at the bedside. This offers the advantage of instant clinical information and has shown to speed up the diagnostic process, and to improve diagnostic accuracy and correct treatment.

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The Diagnostic Accuracy and Prognostic Value of Lung ultrasound in Suspected COVID-19 a retrospective service evaluation

Correspondence, Volume 21, Issue 1, Pages 1-64 (2022)

We read with interest the paper from Knight et al in Acute Medicine in particular the use of a lung ultrasound (LUS) score to predict outcome in patients with suspected COVID-19. LUS has been shown to be useful in the diagnosis and prognosis for COVID-19 by other authors. We have carried out a service evaluation project on our data from East Surrey Hospital looking into prognostic and diagnostic performance of LUS in suspected COVID-19. In contrast to the data used by Knight et al we had discharge diagnosis data available which allowed us to split the cohort into patients with COVID-19 and patients with other diagnoses and compare the LUS score between the two groups.

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The One Minute Preceptor: A Vital Tool During COVID-19

Correspondence, Volume 21, Issue 1, Pages 1-64 (2022)

The One Minute Preceptor (OMP) model of teaching has an important role to play during the COVID-19 pandemic. It’s quick and easy to learn and can be applied to any clinical setting. By responding directly to a student’s needs, and building on the knowledge they already hold, the OMP is able to offer relevant and opportunistic teaching that the learner can immediately apply. Finally, the OMP can be taught in under two hours meaning medical staff not used to regularly teaching can develop the confidence to offer high quality educational interventions.

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Metrics are required for diagnostic accuracy in acute medicine

Correspondence, Volume 21, Issue 1, Pages 1-64 (2022)

The article by Subbe et al raise important considerations as to what is deemed quality care in medicine. Throughput in acute medicine is highly prized. Prompt decision making, and action, is certainly required for several groups of unwell patients, but there is system-wide pressure to maintain this fast pace for all patients. It does not automatically follow that quicker medicine benefits all patients to some degree. ‘Productivity’ may come at the cost of too much medicine - characterised by overdiagnosis, overtreatment, and substantial resource utilisation.

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A Proposal to Establish Acute Medicine Units in Sudan’s Hospitals

Correspondence, Volume 20, Issue 4, Pages 249 – 308 (2021)

This proposal is the first to suggest the establishment of the new specialty of acute medicine in Sudan. Introducing this specialty will ensure that patients receive the best care in a timely fashion from a well-trained workforce and will aid in delivering optimum care to critically ill medical patients and securing faster, safer, and more effective services. It will provide a comprehensive training program for senior and junior doctors and attract employees by creating more jobs for different specialties (nurses, pharmacists, radiologists, etc.). Further, introducing acute care will help reduce the number of patients who require long-term admission, provide more accessible, holistic, emergency medical care for all socio-economic classes, and empower key stakeholders.

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